This cadaveric study challenges the long-held belief that the anterior humeral circumflex artery is the dominant blood supply to the humeral head. Using gadolinium-enhanced MRI in 24 matched cadaver shoulders, the authors quantified the relative contribution of each vessel to humeral head perfusion. The study asks: which artery actually matters more for keeping the humeral head alive after fracture?
For decades, Gerber et al.'s 1990 anatomy study established the anterolateral branch of the anterior humeral circumflex artery as the dominant humeral head supply. This created a paradox: if that vessel drives head viability, why is osteonecrosis relatively uncommon when it is disrupted in 80% of proximal humerus fractures?
This paper resolves that paradox. The posterior humeral circumflex artery is the workhorse vessel, supplying nearly two-thirds of humeral head perfusion and remaining intact in 85% of fractures.
When you are fixing a three- or four-part proximal humerus fracture, protect the posteromedial soft tissue sleeve. Aggressive posteromedial dissection risks the posterior humeral circumflex artery and is the most preventable cause of iatrogenic osteonecrosis.
Clinically, this reframes how to interpret fracture patterns: integrity of the medial hinge and length of the posteromedial metaphyseal extension are the key predictors of head perfusion, not simply whether the anterolateral branch is intact.
This cadaveric study challenges the long-held belief that the anterior humeral circumflex artery is the dominant blood supply to the humeral head. Using gadolinium-enhanced MRI in 24 matched cadaver shoulders, the authors quantified the relative contribution of each vessel to humeral head perfusion. The study asks: which artery actually matters more for keeping the humeral head alive after fracture?
For decades, Gerber et al.'s 1990 anatomy study established the anterolateral branch of the anterior humeral circumflex artery as the dominant humeral head supply. This created a paradox: if that vessel drives head viability, why is osteonecrosis relatively uncommon when it is disrupted in 80% of proximal humerus fractures?
This paper resolves that paradox. The posterior humeral circumflex artery is the workhorse vessel, supplying nearly two-thirds of humeral head perfusion and remaining intact in 85% of fractures.
When you are fixing a three- or four-part proximal humerus fracture, protect the posteromedial soft tissue sleeve. Aggressive posteromedial dissection risks the posterior humeral circumflex artery and is the most preventable cause of iatrogenic osteonecrosis.
Clinically, this reframes how to interpret fracture patterns: integrity of the medial hinge and length of the posteromedial metaphyseal extension are the key predictors of head perfusion, not simply whether the anterolateral branch is intact.